The impact of
patient voice in rehabilitation

Beth Halsne won The Graduate School's Three Minute Thesis Competition for her research on the power of patient input in picking prosthetic feet that work best for them.

Some of the most influential teachers Beth Halsne had in graduate school were the people who her research was designed to help.

Those people had amputations and were using prosthetic feet. Halsne wanted to find out just how impactful their voices were in selecting the best prosthetic feet for their bodies.

This is a different approach when it comes to selecting prosthetic limbs. While there are hundreds of models of prosthetic feet on the market, historically, clinicians pick the foot they think will be best suited for their patients.

But giving the person who needed the limb a voice in the process often changed which type of foot was picked.

“That was powerful because it was making a difference in people’s clinical care and their lives,” Halsne said. “I don’t think it was because patients were choosing feet that were vastly different from the models prescribed. Instead, I think it speaks to the power of people’s individual voices and giving them an opportunity to contribute to the process.”

Halsne graduated from UW in 2021 with a Ph.D. in Rehabilitation Science and Master’s in Mechanical Engineering and is now a researcher in the VA RRD Center for Limb Loss and MoBility (CLiMB) at the VA Puget Sound Health Care System. She is also an affiliate assistant professor in Rehabilitation Medicine at UW.

As an undergraduate at UW, Halsne first became interested in rehabilitation science during a health equity lecture where she was volunteering. The speaker worked with landmine victims in southeast Asia, and shared the complexities of caring for people with traumatic limb loss.

“I loved the marriage of engineering and medicine and this idea that you could provide tangible interventions that really make a difference in someone’s life,” Halsne said.

Beth Halsne works with participants with prosthetic limbs at the Center for Limb Loss and MoBility (CLiMB).

After that, Halsne shifted her focus away from pre-med and joined the Prosthetic & Orthotics program at UW. Post-graduation, she spent the next five years working at medical centers in Michigan and Chicago, studying how to make prosthetics easier for people with amputations to use. There, she was able to combine her love of research and interacting with people.

Building close relationships with her patients over the years was meaningful to Halsne, but also a rare opportunity for practitioners who may only see patients over several months of their lives. For clinicians who work with people with amputations, their relationships last years, as their patient goes through a life changing event that requires constant and long-term monitoring of their healing and prosthetic limb use.

The more Halsne built these close relationships with her patients, the more she wished she had more information to improve how the devices worked for them, especially to match what their goals were for using their new limbs. Delving back into the research side of this work seemed like the best way to do this.

So Halsne moved back to the Seattle-area to attend graduate school. Working with her graduate school adviser, Associate Professor David Morgenroth, MD, Halsne was the lead research assistant on Dr. Morgenroth’s project developing a test drive strategy for people who were getting prosthetic feet, a study that occured at the VA’s Center for Limb Loss and MoBility (CLiMB).

Partnering with the company Humotech, they programmed a robotic foot — called a prosthetic foot emulator — to imitate different types of commercial prosthetic feet, allowing the users to try walking, balancing, and ultimately providing input on which foot they were more satisfied with.

Many of these patients had never been given the option to try out a foot before it was assigned to them. After the study, some of the participants had their prosthetic foot changed because they had found one that better fit their goals and activities.

“Clinicians have an idea of how prosthetic feet might differ based on materials and what they know about biomechanics, but we don’t have objective information to say we know this foot will be better for you as an individual,” Halsne said. “That’s where including the prosthesis user and giving them the experience so they can tell for themselves which ones they will like better is important. They’re contributing something based on actual experience.”

Three people smile at the camera with trees and fields in the background.

Beth Halsne with her son, Miles, and husband, Matt Knowlton.

One of the most challenging and rewarding parts of graduate school for Halsne was what she likes to call her first dissertation, or having her first child. Her son, who is three years old now, required balancing her commitments, but also allowed her to bring her whole self to her graduate school studies, celebrating her identity as a mother, a student, a clinician, and a researcher.

“That’s where the magic is,” she said. “That’s what makes you interested in helping your community, or what drives you back to grad school. It’s something different for everyone and that’s a beautiful thing. If we make ourselves smaller to fit into a certain mold, innovation doesn’t happen.”

Not only is it important to Halsne to bring one’s whole self to their research, but also to explain it well to family, friends, and the greater community. Halsne won the 2021 Three Minute Thesis Competition at UW, for effectively and simply explaining her research in language appropriate for a public audience.

Halsne said the competition was a fun opportunity to tell a compelling story about the research she’d been working on for years. Soliciting feedback early from family and friends helped her condense years of research and eliminate lingo that people outside of her field would not be familiar with.

“It’s good practice; no research should happen in the silo,” Halsne said. “It’s about disseminating worthwhile work and being able to convince other people why this is worth sharing, doing, supporting, and funding.”


By Kate Stringer, UW Graduate School

Published Nov. 22, 2021